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Date z�5/86 <br />Application For <br />PUBLIC WORK� PERMIT <br />Print or Type Only <br />Planned Parenthood 2730 Hoyt <br />Qwner Mai{ing Address 1 <br />Dave Hanson Construction Inc. 1054 Park Drive <br />Applicant <br />Describe Proposed Work <br />Mailing Address <br />Interior remodel and alteration <br />Project Address (it known) �J� <br />"s�-- <br />^ PuElit Worke Permli s <br />aiav. oeP�.: 86/16040 <br />Public Worb Fee <br />Total Fea S <br />Less AO�� Fee Pa1C S <br />Balanca Oue S <br />Everett 98201 339-3389 <br />Zip Phone <br />Everett 98203 259-2950 <br />Zip phone <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Properry Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed siructures on the lol • Show any proposed yrading changes <br />� Existing and propo��� utilities • Show measurements <br />Approvad for <br />PERMIT CONDITIONS <br />1. All calis for inspection shall be made 24 hrs. in advance • phone 259•881 5. <br />2. All work shall be performed in accordance with ihis permit and current City of Everett Design and Construction <br />Standards and Specifications <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />i(/O �a6��� �o,eE� OE,Pi+�, r ,P��.,eE� <br />��6 <br />< <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />�'/i,l'� <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT �:7F CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett from any and all claims for damages, costs, <br />expenses. or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for anA further agrees to remove same upon notice irom the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUfiSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE ��F WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />